MEDICARE: MISS KAMANONIE LATISHA WILEY MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1538325204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KAMANONIE LATISHA WILEY MSW

Provider Business Mailing Address
First Line	:	2470 S DAIRY ASHFORD ST
Second Line	:	137
City	:	HOUSTON
State	:	TX
Zip	:	77077-5716
Country	:	US
Telephone Number	:	281-920-3283
Fax Number	:	281-493-0191

Provider Business Practice Location Address
First Line	:	2470 S DAIRY ASHFORD ST
Second Line	:	137
City	:	HOUSTON
State	:	TX
Zip	:	77077-5716
Country	:	US
Telephone Number	:	281-920-3283
Fax Number	:	281-493-0191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	08/01/2008

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